National Physical Therapy Examination NPTE 2026: Latest
Comprehensive Study Guide with Practice Questions,
Physical Therapy Review, Detailed Rationales, Verified
Answers & Success Workbook
DOMAIN 1: Musculoskeletal System
(Highest Weight: 44–54 Scored Items | 26 Questions)
Domain 1 Tasks Covered: Musculoskeletal examination • Differential diagnosis •
Joint biomechanics • Movement analysis • Connective tissue conditions • Post-
surgical rehabilitation • Manual therapy • Exercise prescription • Special tests and
their clinical application
Question 1. A 45-year-old male presents with right shoulder pain and limited
abduction. Passive range of motion shows pain at 120° of abduction, and a positive
Hawkins-Kennedy test. The MOST likely diagnosis is:
A) Rotator cuff tear
B) Adhesive capsulitis
C) Subacromial impingement syndrome
D) Glenohumeral osteoarthritis
Rationale: Subacromial impingement typically presents with pain during mid-
range abduction and a positive Hawkins-Kennedy test. Adhesive capsulitis (B)
would limit both active and passive ROM throughout the range. Rotator cuff tear
(A) may present with weakness and a positive drop arm test. Osteoarthritis (D)
usually presents with stiffness, crepitus, and limited ROM in multiple directions.
Question 2. A patient has limited ankle dorsiflexion following ORIF of the distal
tibia. To facilitate dorsiflexion, which joint mobilization technique is MOST
appropriate?
A) Posterior glide of the talus on the tibia
B) Lateral glide of the calcaneus on the tibia
C) Posterior glide of the tibia on the talus
D) Anterior glide of the talus on the tibia
,Rationale: To facilitate dorsiflexion, a posterior glide of the talus on the tibia is
performed. This arthrokinematic motion is necessary for normal dorsiflexion. The
convex talus glides posteriorly on the concave tibia during dorsiflexion.
Question 3. A patient with a complete long thoracic nerve injury would have
difficulty with which movement?
A) Shoulder abduction above 90°
B) Shoulder flexion above 90°
C) Shoulder external rotation
D) Shoulder internal rotation
Rationale: The long thoracic nerve innervates the serratus anterior muscle, which
is responsible for upward rotation and protraction of the scapula. Injury results in
scapular winging, making shoulder flexion above 90° difficult due to the inability
to upwardly rotate the scapula.
Question 4. A patient is 8 weeks post-ACL reconstruction. Which of the following
exercises is MOST appropriate at this stage?
A) Plyometric jumping
B) Stationary cycling with progressive resistance
C) Running and cutting drills
D) Deep squats with heavy load
Rationale: At 8 weeks post-ACL reconstruction, the graft is still maturing.
Stationary cycling with progressive resistance is safe and appropriate for
improving range of motion, strength, and cardiovascular fitness. Plyometrics (A)
and running/cutting (C) are typically introduced at 4–6 months. Deep squats with
heavy load (D) may stress the graft.
Question 5. A patient presents with lateral elbow pain after repetitive gripping
activities. Which structure is MOST likely involved?
A) Medial collateral ligament
B) Extensor carpi radialis brevis tendon
C) Ulnar nerve
D) Pronator teres
Rationale: Lateral epicondylitis (tennis elbow) involves the extensor carpi radialis
brevis tendon at its origin on the lateral epicondyle. It is caused by repetitive wrist
extension and gripping. Medial collateral ligament (A) and pronator teres (D) are
,associated with medial elbow pain. Ulnar nerve (C) involvement causes medial
elbow symptoms.
Question 6. Which of the following is the PRIMARY goal during the first week
following total knee arthroplasty?
A) Plyometric training
B) Control swelling and restore knee extension
C) Jogging
D) Heavy resistance training
Rationale: Initial rehabilitation after TKA focuses on controlling edema, restoring
full knee extension, and initiating quadriceps activation. Plyometrics (A), jogging
(C), and heavy resistance (D) are contraindicated in the acute post-operative phase.
Question 7. A patient with a Grade II ankle inversion sprain should be treated with
which of the following in the acute phase?
A) Heat application
B) Rest, ice, compression, and elevation (RICE)
C) Aggressive stretching
D) Immediate weight-bearing without support
Rationale: The acute phase of a Grade II ankle sprain is managed with RICE to
control inflammation and pain. Heat (A) increases swelling. Aggressive stretching
(C) may worsen tissue damage. Unsupported weight-bearing (D) may delay
healing.
Question 8. Which special test is used to assess for a meniscal tear?
A) Lachman test
B) McMurray test
C) Anterior drawer test
D) Valgus stress test
Rationale: The McMurray test is used to assess for meniscal tears by rotating the
tibia while flexing and extending the knee. Lachman (A) and anterior drawer (C)
tests assess ACL integrity. Valgus stress test (D) assesses MCL integrity.
Question 9. A patient has a positive drop arm test. This finding is MOST
consistent with:
, A) Adhesive capsulitis
B) Rotator cuff tear
C) Subacromial impingement
D) Acromioclavicular joint sprain
Rationale: A positive drop arm test indicates a full-thickness rotator cuff tear,
most commonly involving the supraspinatus. Adhesive capsulitis (A) limits both
active and passive ROM. Impingement (C) presents with a painful arc. AC joint
sprain (D) causes pain at the AC joint.
Question 10. A patient is 6 weeks post-total hip arthroplasty (posterior approach).
Which precaution should be observed?
A) No hip flexion beyond 90°
B) No hip abduction
C) No weight-bearing
D) No hip extension
Rationale: Following posterior-approach THA, hip flexion beyond 90°, adduction
beyond midline, and internal rotation are restricted to prevent dislocation.
Abduction (B) is encouraged. Weight-bearing (C) is typically allowed as tolerated.
Hip extension (D) is not restricted.
Question 11. Which of the following is the MOST appropriate intervention for
adhesive capsulitis during the frozen stage?
A) Aggressive end-range stretching
B) Gentle range of motion and pain management
C) High-velocity manipulation
D) Plyometric exercises
Rationale: During the frozen stage of adhesive capsulitis, the capsule is inflamed
and painful. Gentle ROM and pain management are appropriate. Aggressive
stretching (A) and high-velocity manipulation (C) may worsen inflammation.
Question 12. A patient with patellofemoral pain syndrome is MOST likely to
report pain during which activity?
A) Descending stairs
B) Overhead reaching
C) Neck rotation
D) Wrist flexion
Comprehensive Study Guide with Practice Questions,
Physical Therapy Review, Detailed Rationales, Verified
Answers & Success Workbook
DOMAIN 1: Musculoskeletal System
(Highest Weight: 44–54 Scored Items | 26 Questions)
Domain 1 Tasks Covered: Musculoskeletal examination • Differential diagnosis •
Joint biomechanics • Movement analysis • Connective tissue conditions • Post-
surgical rehabilitation • Manual therapy • Exercise prescription • Special tests and
their clinical application
Question 1. A 45-year-old male presents with right shoulder pain and limited
abduction. Passive range of motion shows pain at 120° of abduction, and a positive
Hawkins-Kennedy test. The MOST likely diagnosis is:
A) Rotator cuff tear
B) Adhesive capsulitis
C) Subacromial impingement syndrome
D) Glenohumeral osteoarthritis
Rationale: Subacromial impingement typically presents with pain during mid-
range abduction and a positive Hawkins-Kennedy test. Adhesive capsulitis (B)
would limit both active and passive ROM throughout the range. Rotator cuff tear
(A) may present with weakness and a positive drop arm test. Osteoarthritis (D)
usually presents with stiffness, crepitus, and limited ROM in multiple directions.
Question 2. A patient has limited ankle dorsiflexion following ORIF of the distal
tibia. To facilitate dorsiflexion, which joint mobilization technique is MOST
appropriate?
A) Posterior glide of the talus on the tibia
B) Lateral glide of the calcaneus on the tibia
C) Posterior glide of the tibia on the talus
D) Anterior glide of the talus on the tibia
,Rationale: To facilitate dorsiflexion, a posterior glide of the talus on the tibia is
performed. This arthrokinematic motion is necessary for normal dorsiflexion. The
convex talus glides posteriorly on the concave tibia during dorsiflexion.
Question 3. A patient with a complete long thoracic nerve injury would have
difficulty with which movement?
A) Shoulder abduction above 90°
B) Shoulder flexion above 90°
C) Shoulder external rotation
D) Shoulder internal rotation
Rationale: The long thoracic nerve innervates the serratus anterior muscle, which
is responsible for upward rotation and protraction of the scapula. Injury results in
scapular winging, making shoulder flexion above 90° difficult due to the inability
to upwardly rotate the scapula.
Question 4. A patient is 8 weeks post-ACL reconstruction. Which of the following
exercises is MOST appropriate at this stage?
A) Plyometric jumping
B) Stationary cycling with progressive resistance
C) Running and cutting drills
D) Deep squats with heavy load
Rationale: At 8 weeks post-ACL reconstruction, the graft is still maturing.
Stationary cycling with progressive resistance is safe and appropriate for
improving range of motion, strength, and cardiovascular fitness. Plyometrics (A)
and running/cutting (C) are typically introduced at 4–6 months. Deep squats with
heavy load (D) may stress the graft.
Question 5. A patient presents with lateral elbow pain after repetitive gripping
activities. Which structure is MOST likely involved?
A) Medial collateral ligament
B) Extensor carpi radialis brevis tendon
C) Ulnar nerve
D) Pronator teres
Rationale: Lateral epicondylitis (tennis elbow) involves the extensor carpi radialis
brevis tendon at its origin on the lateral epicondyle. It is caused by repetitive wrist
extension and gripping. Medial collateral ligament (A) and pronator teres (D) are
,associated with medial elbow pain. Ulnar nerve (C) involvement causes medial
elbow symptoms.
Question 6. Which of the following is the PRIMARY goal during the first week
following total knee arthroplasty?
A) Plyometric training
B) Control swelling and restore knee extension
C) Jogging
D) Heavy resistance training
Rationale: Initial rehabilitation after TKA focuses on controlling edema, restoring
full knee extension, and initiating quadriceps activation. Plyometrics (A), jogging
(C), and heavy resistance (D) are contraindicated in the acute post-operative phase.
Question 7. A patient with a Grade II ankle inversion sprain should be treated with
which of the following in the acute phase?
A) Heat application
B) Rest, ice, compression, and elevation (RICE)
C) Aggressive stretching
D) Immediate weight-bearing without support
Rationale: The acute phase of a Grade II ankle sprain is managed with RICE to
control inflammation and pain. Heat (A) increases swelling. Aggressive stretching
(C) may worsen tissue damage. Unsupported weight-bearing (D) may delay
healing.
Question 8. Which special test is used to assess for a meniscal tear?
A) Lachman test
B) McMurray test
C) Anterior drawer test
D) Valgus stress test
Rationale: The McMurray test is used to assess for meniscal tears by rotating the
tibia while flexing and extending the knee. Lachman (A) and anterior drawer (C)
tests assess ACL integrity. Valgus stress test (D) assesses MCL integrity.
Question 9. A patient has a positive drop arm test. This finding is MOST
consistent with:
, A) Adhesive capsulitis
B) Rotator cuff tear
C) Subacromial impingement
D) Acromioclavicular joint sprain
Rationale: A positive drop arm test indicates a full-thickness rotator cuff tear,
most commonly involving the supraspinatus. Adhesive capsulitis (A) limits both
active and passive ROM. Impingement (C) presents with a painful arc. AC joint
sprain (D) causes pain at the AC joint.
Question 10. A patient is 6 weeks post-total hip arthroplasty (posterior approach).
Which precaution should be observed?
A) No hip flexion beyond 90°
B) No hip abduction
C) No weight-bearing
D) No hip extension
Rationale: Following posterior-approach THA, hip flexion beyond 90°, adduction
beyond midline, and internal rotation are restricted to prevent dislocation.
Abduction (B) is encouraged. Weight-bearing (C) is typically allowed as tolerated.
Hip extension (D) is not restricted.
Question 11. Which of the following is the MOST appropriate intervention for
adhesive capsulitis during the frozen stage?
A) Aggressive end-range stretching
B) Gentle range of motion and pain management
C) High-velocity manipulation
D) Plyometric exercises
Rationale: During the frozen stage of adhesive capsulitis, the capsule is inflamed
and painful. Gentle ROM and pain management are appropriate. Aggressive
stretching (A) and high-velocity manipulation (C) may worsen inflammation.
Question 12. A patient with patellofemoral pain syndrome is MOST likely to
report pain during which activity?
A) Descending stairs
B) Overhead reaching
C) Neck rotation
D) Wrist flexion
